Tissue repair device

ABSTRACT

The present disclosure relates to a tissue repair device. The device includes a handle, a knob coupled to the handle, and a needle coupled to the handle. The needle includes a proximal end and a distal end, the distal end including a slot, wherein a first anchor is housed within the distal end and a second anchor is housed within the slot and located proximal to the first anchor. An actuator disposed within the needle and operatively coupled to the knob, wherein advancement of the knob allows for engagement of the actuator with the first anchor and subsequent advancement of the first anchor via the actuator. A method of tissue repair is also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.16/506,181, filed on Jul. 9, 2019, entitled TISSUE REPAIR DEVICE, whichin turn is a continuation of U.S. application Ser. No. 15/391,287, filedon Dec. 27, 2016, which in turn is a continuation of U.S. applicationSer. No. 14/242,171, filed on Apr. 1, 2014, now U.S. Pat. No. 9,549,725,which in turn is a continuation of U.S. application Ser. No. 12/623,930,filed on Nov. 23, 2009, now U.S. Pat. No. 8,888,798, which claimspriority to U.S. Provisional Application No. 61/255,995, filed on Oct.29, 2009, U.S. Provisional Application No. 61/166,907, filed on Apr. 6,2009, and U.S. Provisional Application No. 61/117,987, filed on Nov. 26,2008. The contents of all of the above-identified applications areincorporated herein by reference in their entirety for all purposes.

BACKGROUND Field of Technology

The present disclosure relates to devices and methods for repairingtissue.

Related Art

Areas in the body where tissue can be surgically reattached to bone orcan be surgically repaired when a tear forms in the tissue include, butare not limited to, the biceps tendon, the lateral collateral ligamentin the knee, the medial collateral ligament in the knee, the meniscus inthe knee, the popliteal ligament in the leg, and the labrum tendon inthe knee.

Fibrous tissue wounds, such as muscle, ligament, and meniscal tears, canbe repaired arthroscopically using sutures. Traditionally, to close afibrous tissue wound, a surgeon would insert two suture needles into thetissue with sutures attached, thread the sutures across the wound, andthen tie knots to fix the free ends of the sutures within the tissue.

To simplify the wound closure and to improve fixation, various types ofdevices, and tools for use in delivering the devices, have beendeveloped. One example of a device is the FAST-FIX™ device, which isdesigned to repair tears in soft tissue, such as the meniscus. Thisdevice, and other devices for use in wound closure, is shown anddescribed in U.S. Pat. No. 7,153,312, US Patent Application Publication2003/0130694, US Patent Application Publication US 2005/0283192, and USPatent Application Publication 2005/0033363, the disclosures of whichare incorporated herein by reference in their entireties.

SUMMARY

In one aspect, the present disclosure relates to a tissue repair device.The device includes a handle having a knob coupled to the handle, aneedle coupled to the handle, the needle including a proximal end and adistal end, the distal end including a slot, wherein a first anchor ishoused within the distal end and a second anchor is housed within theslot and located proximal to the first anchor, and an actuator disposedwithin the needle and operatively coupled to the knob, whereinadvancement of the knob allows for engagement of the actuator with thefirst anchor and subsequent advancement of the first anchor via theactuator.

In another aspect, the present disclosure relates to a method of tissuerepair. The repair includes providing a tissue repair device comprisinga handle, a knob coupled to the handle, a needle coupled to the handle,a first anchor and a second anchor coupled to the needle, the firstanchor coupled to the second anchor via a flexible member, and anactuator disposed within the needle and operatively coupled to the knob;inserting the needle through tissue, the tissue including a tear, theneedle being inserted through the tissue on one side or the tear;advancing the knob of the device to engage the actuator with the firstanchor and advance the first anchor out of the needle; removing theneedle from the tissue and re-inserting the needle through the tissue onan opposite side of the tear; advancing the knob of the device to engagethe actuator with the second anchor and advance the second anchor out ofthe needle; and removing the needle from the tissue and reducing alength of the flexible member between the first and second anchor tobring sides of the tear into juxtaposition.

Further areas of applicability of the present disclosure will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and specific examples, whileindicating the preferred embodiment of the disclosure, are intended forpurposes of illustration only and are not intended to limit the scope ofthe disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and form a part ofthe specification, illustrate the embodiments of the present disclosureand together with the written description serve to explain theprinciples, characteristics, and features of the disclosure. In thedrawings:

FIG. 1 shows a perspective view of a first embodiment of the tissuerepair device of the present disclosure.

FIG. 2 shows a side view of the tissue repair device of FIG. 1.

FIG. 3 shows a cross-sectional view of the handle of the tissue repairdevice of FIG. 1.

FIG. 4 shows a cross sectional view of the tissue repair device of FIG.1.

FIG. 5 shows another cross sectional view of the tissue repair device ofFIG. 1.

FIGS. 6A-6B show a cross-sectional view and a perspective view of thedistal end of the needle of the tissue repair device of FIG. 1.

FIGS. 7A-7E show a method of tissue repair via use of the tissue repairdevice of the present disclosure.

FIGS. 8A-8B show advancement of the knob of the tissue repair device ofFIG. 1 during the method of tissue repair.

FIG. 9A shows a perspective view of an a second embodiment of the tissuerepair device of the present disclosure.

FIG. 98 shows a side view of the tissue repair device of FIG. 9A.

FIG. 9C shows a cross-sectional side view of the tissue repair device ofFIG. 9A.

FIG. 10 shows an isometric view of the handle of the tissue repairdevice of FIGS. 9A-9C.

FIG. 11A shows an isometric view of the knob of the tissue repair deviceof FIGS. 9A-9C.

FIG. 11B shows a cross-sectional view of the knob of FIG. 11A.

FIG. 12A shows an isometric view of the tubing of the tissue repairdevice of FIGS. 9A-9C.

FIG. 12B shows a cross-sectional view of the tubing of FIG. 12A.

FIG. 13A shows an isometric view of the pusher assembly of the tissuerepair device of FIGS. 9A-9C.

FIG. 13B shows an isometric view of the pusher assembly of the tissuerepair device of FIGS. 9A-9C with the pusher disk and coiled spring.

FIG. 14 shows an isometric view of the distal end of the actuator ofFIGS. 13A-13B.

FIG. 15 shows an isometric view of the pusher disk of the pusherassembly of FIG. 13B.

FIG. 16A shows an isometric view of the hub of the tissue repair deviceof FIGS. 9A-9C.

FIG. 168 shows an isometric view of a first part of the huh of FIG. 16A.

FIG. 16C shows an isometric view of a second part of the hub of FIG.16A.

FIG. 17A shows an isometric view of the needle assembly of the tissuerepair device of FIGS. 9A-9C.

FIG. 17B shows an isometric view of the distal end of the needleassembly of FIG. 17A.

FIGS. 18A-18B show isometric views of the distal end of the needleassembly of FIG. 9B with anchors and a transparent tube.

FIG. 19 shows an isometric view of a first anchor of the tissue repairdevice of FIGS. 9A-9C.

FIG. 20 shows a side view of a second anchor of the tissue repair deviceof FIGS. 9A-9C.

FIG. 21 shows an isometric view of the depth tube of the tissue repairdevice of FIGS. 9A-9C.

FIG. 22A shows an isometric view of the depth tube of FIG. 21 with theslider coupled to the depth tube and the hub.

FIG. 22B shows a side view of the slider, depth tube, and hub of FIG.22A.

FIG. 23 shows an isometric view of the slider of FIG. 22A.

FIG. 24A shows an isometric view of the distal end of the tissue repairdevice of FIGS. 9A-9C with sutures.

FIG. 24B shows another isometric view of the distal end of the tissuerepair device of FIG. 24A without sutures.

FIG. 24C shows a cross-sectional view of the distal end of the tissuerepair device of FIGS. 9A-9C

FIG. 24D shows a cross-sectional view of the tissue repair device ofFIGS. 9A-9C, specifically the pusher assembly prior to deployment of thefirst anchor.

FIG. 25 shows a cross-sectional view of the pusher assembly of thetissue repair device of the present disclosure during deployment of thefirst anchor.

FIG. 26A shows a cross-sectional view of the pusher disk afterdeployment of the first anchor,

FIG. 26B shows a cross-sectional view of the distal end of the tissuerepair device of the present disclosure after deployment of the firstanchor and prior to deployment of the second anchor.

FIGS. 27-30 show a method of tissue repair via use of the tissue repairdevice of FIGS. 9A-9C.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The following description of the preferred embodiment(s) is merelyexemplary in nature and is in no way intended to limit the disclosure,its application, or uses.

FIGS. 1-5 show a first embodiment the soft tissue repair device 10 ofthe present disclosure. The device 10 includes a handle 11 and a cannula12 coupled to the handle 11. The handle 11 includes a body 11 a and anose cone 11 b coupled to the body 11 a. The nose cone 11 b includes a

proximal end 11 b′ and a distal end 11 b″. The body 11 a includes acavity 11 a′ and a J-shaped channel 13 (FIGS. 1 & 8A-8B). The channel 13includes a first portion 13 a and a second portion 13 b. A pusher 14 ishoused within the cavity 11′. The pusher 14 includes a body 14 a, ashaft 14 b coupled to the body 14 a, and a pin 14 c coupled to the body14 a. The pin 14 c includes a distal portion 14 c′ that extends throughthe channel 13 and a proximal portion 14 c″ that is coupled to the body14 a. In addition, the cavity 11 a′ includes a coil 15, wherein one end15 a of the coil 15 is coupled to the pusher body 14 a and the other end15 b of the coil 15 is coupled to the proximal end 11 b′ of the nosecone 11 b, as shown in FIG. 3. Furthermore, a knob 16 is disposed on thebody 11 a of the handle 11. The knob 16 includes an aperture 16 a thathouses the distal portion 14 c′ of the pin 14 e. The coil 15, as shownin FIG. 3, is in a released position when the knob 16 is in a startingposition and becomes compressed when the knob 16 is advanced toward thenose cone 11 b, as shown in FIGS. 4 & 5.

The cannula 12 includes a proximal end 12 a and a distal end 12 b. Theproximal end 12 a is partially housed within a through hole 11 b′″ ofthe nose cone 11 b and includes areas of reduced diameter 12 a′. Aneedle 17 is disposed within the cannula 12 and includes a proximal end17 a and a distal end 17 b. The proximal end 17 a is partially housedwithin the through hole 11 b′″ of the nose cone 11 b and the distal end17 b includes a beveled, pointed tip 17 e and a slot 17 b′. As shown inFIGS. 6A and 6B, a first anchor 20 is housed within the distal end 17 bof the needle 17 and a second anchor 30 is housed within the slot 17 b′and located proximal to the first anchor 20. The anchors 20,30 arecoupled via a flexible member 40, such as a suture, that includes a slipknot 41 located between the anchors 20,30. The suture 40 is coupled tothe anchors 20,30 and the slip knot 41 is formed via the methodsdescribed in the above incorporated US patents and publishedapplications. A free end 42 extends from the slip knot 41 and the suturelength between the anchors 20,30 is reduced upon pulling the free end 42in one direction, but not in another direction, as will be furtherdescribed below.

The distal end 17 b also includes laser marks 17 b″ that are used duringrepair to indicate the depth of the needle 17, as will be furtherdescribed below. An actuator 18 is disposed within the needle 17 andincludes a distal end 18 a engaged with the first anchor 20 and aproximal end 18 b coupled to the pusher shaft 14 b. A depth indicator 19is disposed over the cannula 12 and the needle 17. The indicator 19includes a proximal end 19 a and a distal end 19 b. The proximal end 19a includes at least two tabs 19 a′ that engage the areas of reduceddiameter 12 a′ and couple the indicator 19 to the cannula 12. Prior torepair, the indicator 19 is coupled to the cannula 12 such that thedistal end 19 b covers the distal end 17 b of the needle 17. FIG. 6Ashows the distal ends 17 b,19 b of the needle 17 and the indicator 19.As shown, the first anchor 20 is within the distal end 17 b of theneedle 17 and the second anchor 30 is within the opening 17 b′, suchthat the actuator 18 is located below the second anchor 30 and thedistal end 18 a is in engagement with the first anchor 20.

Referring to FIGS. 7A-7E, in use, preferably under arthroscopicguidance, the user inserts the device 10 into, for example, the kneejoint, until the distal end 19 b of the indicator 19 is in contact withthe superior surface of the meniscus 50, as shown in FIG. 7A. Theindicator 19 is then moved proximally toward the nose cone 11 b touncover the distal end 17 b of the needle 17, and determine theappropriate needle insertion depth, as shown in FIG. 7B. In practice,enough of the needle 17 should be exposed to allow for insertion of theneedle 17 through the meniscus and subsequent delivery of the anchor 20,but not so much that the needle 17 will extend into areas behind themeniscus, such as neurovascular areas, where it could cause damage.Insertion of the end 17 b through the meniscus 50 occurs until theappropriate laser mark 17 b″ is reached and the knob 16 is then moveddistally toward the nose cone 11 b to deploy the first anchor 20, asshown in FIG. 7C. Before deployment of the first anchor 20, the pin 14 cis located in the first portion 13 a of the channel 13, as shown in FIG.8A. However, after deployment of the first anchor 20, the pin 14 c islocated in the second portion 13 b of the channel 13, as shown in FIG.8B.

Once the first anchor 20 has been deployed, the needle 17 is removedfrom the meniscus 50 and re-inserted across the tear 51, as shown inFIG. 7D. The knob 16 is, once again, moved distally toward the nose cone11 b to deploy the second anchor 30. The device 10 is subsequentlyremoved from the knee joint and the free end 42 is pulled in thedirection of arrow 60. This shortens the length of suture betweenanchors 20,30, bringing sides of tear 51 into juxtaposition, as shown inFIG. 7B. Depending on the length of suture between anchors 20,30, theslip knot 41 will either be on the tissue surface or move within thetissue 50. Slip knot 41 allows the suture 40 to slide in the directionof arrow 61, but does not allow the suture 40 to slide in the oppositedirection 60. The tension placed on suture 40 by pulling on the suture40 relative to anchors 20,30 acts to turn the anchors 20,30 such thattheir long sides are in contact with tissue surface. Excess suture 40can then be cut off. Further manipulation of suture 40 is not needed tosecure anchors 20,30, although the surgeon may wish to provideadditional fastening as a back-up securement measure.

For the purposes of this disclosure, the handle 11, nose cone 11 b,pusher 14, shaft 14 b, knob 16, actuator 18, cannula 12, and depthindicator 19 are of a non-metal material, but may be made from a metalmaterial. In addition, the coil 15, pin 14 c, and needle 17 are of abiocompatible metal material, such as stainless steel. The anchors 20,30and suture 40 are of a non-metal material, such as a polymer material,and may or may not be absorbable. The handle 11 and nose cone 11 b maybe coupled via mechanical means, adhesive means, such as a non-toxic,biocompatible, adhesive glue, or other means known to one of skill inthe art. In addition, the cannula 12 and needle 17 are coupled to thenose cone 11 b, the actuator 18 is coupled to the shaft 14 b, and thecoil 15 is coupled to the nose cone 11 b and the pusher 14 via similarmeans. The device 10 and its components are all made via a method knownto one of skill in the art.

FIGS. 9A-9C show an alternative embodiment of the soft tissue repairdevice 100 of the present disclosure. The components of the device 100will be described with reference to FIGS. 10, 11A-11B, 12A-12B, 13A-13B,14, 15, 16A-16C, 17A-17B, 18A-18B, 19, 20, 21A-21B, 22A-22B, and 23. Thedevice 100 includes a handle 110 which, as shown in FIG. 10, includes aclosed-ended proximal portion 110 a, an open distal portion 110 b, acannulation 110 c, and an outer surface 110 d including holes 110 e onopposite sides of the handle 110. The purpose of the holes 110 e will befurther described below. Disposed within the handle 110 is a knob 120.As shown in FIGS. 11A-11B, the knob 120 includes a shaft 121, a head 122coupled to the shaft 121, and a cannulation 123. The head 122 includes aflange 122 a and a neck 122 b, both of which have a larger diameter thanthe shaft 121. The flange 122 a includes depressions 122 a′. The innerwall 122 c of the head 122 includes several grooves 122 c′. The shaft121 includes an outer wall 121 a having slots 121 b and an inner wall121 c. Coupled to the inner wall 121 c is a rod 121 d having acannulation 121 d′. The cannulation 121 d′ has a “D” shape, such that aportion of the cannulation 121 d′ is flat and the rest of thecannulation is rounded. The rod 121 d includes a first portion 121 e anda second portion 121 f. The first portion 121 e includes a face 121 e′having spikes 121 e″ and divots 121 e′″ located between the spikes 121e″. An end 121 f′ of the second portion 121 f includes legs 121 g thatextend between an outer surface 121 f″ of the second portion 121 f to aninner wall 121 c of the shaft 121.

Disposed within the cannulation 123 of the knob 120 and, therefore thehandle 110, is a tubing 130. As shown in FIGS. 12A-12B, the tubing 130includes a proximal portion 131, a distal portion 132, an outer surface133, an inner surface 134, and a cannulation 135. The proximal portion131 of the tubing 130 includes slots 136 that divide the proximalportion 131 into two sides 131 a,131 b. Both sides 131 a,131 b of theproximal portion 131 include tabs 137 that extend outward from the outersurface 133 of the tubing 130. When the tubing 130 is disposed withinthe handle 110, the tabs 137 are disposed within the holes 110 e of thehandle 110, thereby coupling the tubing 130 to the handle 110. Thedistal portion 132 of the tubing 130 includes channels 132 a located onopposite sides of the distal portion 132. A hole 138 is located at anend 132 a′ of each channel 132 a. The purpose of the channels 132 a andthe holes 138 will be further described below. The distal portion 132also includes rails 139 and slots 132 b,132 c located between the rails139. Slots 132 b,132 c both extend an entire length of the rails 139.However, slot 132 b includes two regions 132 b′,132 b″ having differentdepths, such that a stepped region 132 b′″ is present along the slot 132b, as is more clearly shown in FIG. 12B.

Also disposed within the handle 110 is a pusher assembly 140. The pusherassembly 140 is shown in FIG. 13B. FIG. 13A shows the pusher assembly140 without the coiled spring 150 or the pusher disk 160. The assembly140 includes a shaft 141 and an actuator 142 coupled to the shaft 141.The shaft 141 includes a proximal portion 141 a and a distal portion 141b. The proximal portion 141 a includes a flat portion 141 a′, such thatthe proximal portion 141 a is in the shape of a “D”. As mentioned above,the cannulation 121 d′ of the rod 121 d also has a “D” shape. As isshown in FIG. 9C, the proximal portion 141 a of the shaft 141 is housedwithin the cannulation 121 d′ of the rod 121 d, such that the flatportions of the cannulation 121 d′ and the proximal portion 141 a areadjacent to each other, thereby coupling the pusher assembly 140 to theknob 120. As will be further described below, during operation, the “D”shapes of the cannulation 121 d′ and the proximal portion 141 a allowfor axial movement of the proximal portion 141 a within the cannulation121 d′ and restrict rotational movement of the proximal portion 141 awithin the cannulation 121 d′.

The distal portion 141 b includes a flanged cap 141 e located on thedistal portion 141 b and an inner channel 141 b′. The flanged cap 141 cincludes a cap 141 c′ and a flange 141 c″. The flanged cap 141 c islocated on the distal portion 141 b such that there is an area ofreduced diameter 141 d located between the proximal portion 141 a andthe flange 141 c″. The distal portion 141 b is configured for attachmentof a pusher disk 160 as will be further described below with regard toFIG. 15.

The actuator 142 includes a proximal portion 142 a and a distal portion142 b. The proximal portion 142 a is housed within the inner channel 141b′, thereby coupling the actuator 142 to the shaft 141. As shown in FIG.14, the distal portion 142 b of the actuator 142 includes a flat topportion 142 h′, a rounded bottom portion 142 b″, and a beveled endportion 142 b′″. The top portion 142 b′ and the end portion 142 b′″ areshaped to engage a tissue anchor, as will be further described below. Acoiled spring 150 is disposed on the actuator 142 such that an end 150 aof the spring 150 rests against the cap 141 c′, as shown more clearly inFIG. 13R. As will be further described below, it is important that theend 150 a of the spring 150 rest against the cap 141 c′ rather than thepusher disk 160 so as to not restrict rotation of the pusher disk 160during operation of the device 100.

As shown in FIG. 15, the pusher disk 160 includes a cannulation 161, afront portion 162, a back portion 163, an inner surface 164, and anouter surface 165. Protrusions 166 are located on the outer surface 165of the disk 160. The cannulation 161 includes a first portion 161 a, asecond portion 161 b, and a third portion 161 c. The second portion 161b has a smaller diameter than both of the first and third portions 161a,161 c, such that coupling of the pusher disk 160 to the distal portion1416 results in the second portion 161 b being disposed within the areaof reduced diameter 141 d. In addition, the first and third portions 161a,161 c are of a diameter such that during operation of the device 100the disk 160 is capable of rotating without restriction from either theflange 141 c″ or the proximal portion 141 a. The back portion 163 of thedisk 160 includes spikes 163 a and divots 163 h located between thespikes 163 a. During operation of the device 100, the spikes 163 a anddivots 163 b engage the spikes 121 e″ and divots 121 e′″ of the rod 121d and the rails 139 of the tubing 130, as will be further describedbelow. In addition, during operation, the protrusions 166 slide withinthe slots 132 b,132 c of the tubing 130, as will be further describedbelow.

FIGS. 16A-16C show a two-part hub 170. The hub 170 includes a first part171, as more clearly shown in FIG. 16B, and a second part 172, as moreclearly shown in FIG. 16C. Both the first part 171 and the second part172 include a first section 171 a,172 a and a second section 171 b,172b. The first sections 171 a,172 a include a depression 171 a′,172 a′ andgrooves 171 a″,172 a″. The second sections 171 b,172 b include a channel171 b′,172 b′ and at least two bosses 171 b″,172 b″ located within eachchannel 171 b′,172 b′. The first part 171 also includes pins 171 c that,upon coupling of the first part 171 and the second part 172 to form thehub 170, are disposed within holes 172 c on the second part 172. Eachpart 171,172 also includes tabs 171 d, 172 d located on an outer surface171 b′″,172 b′″ of the second sections 171 b,172 b. As shown in FIG. 9C,the second section 171 b,172 b is housed within the cannulation 135 ofthe tubing 130 such that the tabs 171 d,172 d are disposed within theholes 138 of the tubing 130, thereby coupling the hub 170 to the tubing130.

FIGS. 17A and 17B show a needle assembly 180. The assembly 180 includesa disposal rod 181 and a needle 182 disposed within the rod 181. The rod181 includes a proximal portion 181 a, a distal portion 181 b, and aninner channel 181 c. The proximal portion 181 a includes depressions 181a′ on opposite sides of the proximal portion 181 a. As shown in FIG. 9C,the needle assembly 180 is disposed within the hub 170, such that thebosses 171 b″,172 b″ for both parts 171,172 are disposed within thedepressions 181 a′, thereby coupling the assembly 180 to the hub 170.The distal portion 181 b includes a flange 181 b′. It is within thescope of this disclosure that the distal portion 181 b includes morethan one flange 181 b′. The needle 182 includes a proximal portion (notshown) housed within the inner channel 181 e of the rod 181 and a distalportion 182 b including a beveled tip 182 b′, a slot 182 b″ extendingfrom the beveled tip 182 b′ and including a front portion 182 d, a backportion 182 e, and two sides 182 f, and laser marks 182 b′″. The lasermarks 182 b′″ are used during repair to indicate the depth of the needle182, as will be further described below.

As shown in FIGS. 18A and 18B, anchors 190,1000, which are more clearlyshown in FIGS. 19 and 20, are coupled to the distal portion 182 b of theneedle 182. Both anchors 190,1000 include holes 190 a,1000 a and slots190 b,1000 b. The second anchor 1000 includes channels 1000 e onopposite sides of the anchor 1000 and a protrusion 1010. The secondanchor 1000 is coupled to the needle 182, such that the sides 182 f ofthe slot 182 b″ are housed within the channels 1000 c and the backportion 182 e of the slot 182 b″ is within slot 1000 b. Also shown inFIGS. 18A-18B is a cannulated, transparent tube 200. The tube 200includes a proximal portion 200 a, which is disposed over the distalportion 181 b of the rod 181 such that the flange 181 b′ engages aninner wall 200 c of the tube 200, and a distal portion 200 b is disposedover the protrusion 1010 of the second anchor 1000. The protrusion 1010allows for an increased amount of interference between the distalportion 200 b of the tube 200 and the anchor 1000 when the distalportion 200 b is disposed over the protrusion 1010 of the anchor 100.This increased amount of interference increases the retention of theanchor 1000 to the needle 182.

The actuator 142 is disposed within needle 182 such that the end portion142 b′″ of the actuator 142 is located proximal to the first anchor 190and distal to the second anchor 1000.

FIG. 21 shows a depth tube 300, which includes a first portion 300 a, asecond portion 300 b, and a cannulation 300 e. As shown in FIGS. 1C and22A-22B, a slider 400, which is more clearly shown in FIG. 23, iscoupled to the depth tube 300 such that a shaft 401 of the slider 400 ishoused within the second portion 300 b of the depth tube 300. The slider400 includes the shaft 401, a housing 402 coupled to the shaft 401, anda cannulation 403. The shaft 401 includes a distal portion 401 a and aproximal portion 401 b having a diameter such that the shaft 401 engagesan inner wall 300 b′ of the second portion 300 b, thereby coupling theslider 400 to the depth tube 300. The housing 402 includes a top portion402 a, a bottom portion 402 b, and an opening 402 c. The top portion 402a includes tabs 402 a′. As shown in FIG. 22B, the housing 402 is locatedwithin the hub 170 such that the tabs 402 a′ are located within thegrooves 171 a″,172 a″. The needle assembly 180 is housed within thecannulation 300 c of the depth tube 300. Longitudinal movement of thedepth tube 300 occurs via pressing on the top portion 402 a of thehousing 402 in a direction towards the bottom portion 402 b, so as toremove the tabs 402 a′ from one of the grooves 171 a″,172 a″, moving thehousing 402 longitudinally in a proximal direction towards or away fromthe handle 110, and then releasing the top portion 402 a such that thelabs 402 a′ are deposited into other one of the grooves 171 a″,172 a″.

As shown in FIG. 24A, the anchors 190,1000 are coupled via a flexiblemember 500, such as a suture, that includes a slip knot 501 locatedbetween the anchors 190,1000. The suture 500 is coupled to the anchors190,1000 and the slip knot 501 is formed via the methods described inthe above incorporated US patents and published applications. A free end502 extends from the slip knot 501 and the suture length between theanchors 190,1000 is reduced upon pulling the free end 502 in onedirection, but not in another direction, as will be further describedbelow.

Referring to FIGS. 27-30, in use, preferably under arthroscopicguidance, the user inserts the device 100 into, for example, the kneejoint, until the beveled tip 182 b′ of the needle 182 is in contact withthe superior surface of the meniscus 700, as shown in FIG. 27. At thistime, the device 100, and especially the starting position of itscomponents, is as shown in FIGS. 24B-24D. Namely, as stated above, theend portion 142 b′″ of the actuator 142 is located proximal to the firstanchor 190 and distal to the second anchor 1000 and a distal portion 200b of the tube 200 is disposed over at least a portion of the secondanchor 1000. The first portions 171 a, 172 a of the hub 170, andspecifically the fronts (FIG. 22A, 171 a″,172 a″) of portions 171 a,172a are aligned with the markings 300 d of the second portion 300 b.Similarly, as can be seen in FIG. 27, the front 300 a′ of the depth tube300 is aligned with the markings 182 b′″ of the needle 182. Duringrepair, as the depth tube 300 is moved longitudinally along the needle182, the fronts 171 a″, 172 a″, 300 a′ of the hub 170 and the depth tube300 will continue to align with the markings 300 d, 182 b′″ such thatthe markings 300 d, 182 b′″ that the fronts 171 a″, 172 a″, 300 a′ arealigned with will be equivalent to each other. For example, when fronts171 a″, 172 a″ are aligned with marking 300 d that corresponds to 1 mm,front 300 a′ is aligned marking 182 b′″ that corresponds with 1 mm.

Optionally, the depth tube 300 is disposed over the needle assembly 180and, after insertion of the device 100 into the joint, the tube 300 ismoved proximally, in a manner as described above, toward the knob 120 touncover the distal end 182 b of the needle 182, and determine theappropriate needle insertion depth, which the laser marks 182 b′″, 300 dmay be used for. In practice, enough of the needle 182 should be exposedto allow for insertion of the needle 182 through the meniscus andsubsequent delivery of the anchor 190, but not so much that the needle182 will extend into areas behind the meniscus, such as neurovascularareas, where it could cause damage.

In addition to the starting position of the beveled tip 182 b′ of theneedle 182, the starting position of the disk 160 is shown in FIG. 24D.The disk 160 is located such that the protrusions 166 are located inslots 132 b, specifically region 132 b′, and the spikes 163 a of theprotrusions 166 rest against stepped region 132 b′″.

Insertion of the end 182 b through the meniscus 700 occurs until thedepth tube 300 prevents the needle 182 from being inserted any furtheror the user decides to discontinue insertion of the needle 182. The knob120 is then moved distally over the hub 170 to deploy the first anchor190, as shown in FIG. 28. At this time, the position of the pusher disk160 is shown in FIG. 25. Specifically, movement of the knob 120 in adistal direction pushes the disk 160 out of slot 132 b. In addition,knob movement causes engagement to occur between spikes 163 a of disk160 and spikes 121 e″ of rod 121 d″, thereby causing the disk 160 topartially rotate. After deployment of the first anchor 190, the knob 120is moved proximally toward the handle 110. Upon movement of the knob 120in a proximal direction, the protrusions 166 of the knob 120 engage therails 139, which cause another partial rotation of the disk 160, therebylocating the protrusions 166 in slots 132 c. Once the protrusions 166are located in slots 132 c, the disk 160 continues to move in theproximal direction until the head 122 of the knob 120 rests against thehandle 110, as shown in FIG. 26A. FIG. 26A also shows the back portion163 of the disk 160 resting against the face 121 e′ of the rod 121 d″.As shown in FIG. 26B, when the disk 160 is positioned as shown in FIG.26A, the end portion 142 b′″ of the actuator 142 is located proximal tothe second anchor 1000.

Once the first anchor 190 has been deployed, the needle 182 is removedfrom the meniscus 700 and re-inserted across the tear 701, as shown inFIG. 29. The knob 120 is, once again, moved distally over the hub 170 todeploy the second anchor 1000. Specifically, when the end portion 142b′″ of the actuator 142 is located proximal to the second anchor 1000,the end portion 142 b′″ is flipped upward, as shown in FIG. 26B, whichallows the end portion 142 b′″ to engage the anchor 1000 and be insertedinto the slot 1000 b upon movement of the knob 120 in a distaldirection. Further movement of the actuator 142 pushes the anchor 1000out of the needle 182. In addition, knob movement in a distal directioncauses the disk 160 to be dispelled from the slot 132 b, thereby causingthe disk 160 to partially rotate. After deployment of the second anchor1000, the knob 120 is moved proximally toward the handle 110. Uponmovement of the knob 120 in a proximal direction, the protrusions 166 ofthe disk 160 engage the rails 139, which cause another partial rotationof the disk 160, thereby locating the protrusions 166 in slots 132 b.Once the protrusions 166 are located in slots 132 b, the disk 160continues to move in the proximal direction until the spikes 163 a ofthe protrusions 166, once again, rest against stepped region 132 b′″, asshown in FIG. 24D.

The device 10 is subsequently removed from the knee joint and the freeend 502 is pulled in the direction of arrow 600. This shortens thelength of suture between anchors 190,1000, bringing sides of tear 701into juxtaposition, as shown in FIG. 30. Depending on the length ofsuture between anchors 190,1000, the slip knot 501 will either be on thetissue surface or move within the tissue 700. Slip knot 501 allows thesuture 500 to slide in the direction of arrow 601, but does not allowthe suture 500 to slide in the opposite direction 600. The tensionplaced on suture 500 by pulling on the suture 500 relative to anchors190,1000 acts to tarn the anchors 190,1000 such that their long sidesare in contact with tissue surface. Excess suture 500 can then be cutoff. Further manipulation of suture 500 is not needed to secure anchors190,1000, although the surgeon may wish to provide additional fasteningas a back-up securement measure.

For the purposes of this disclosure, the needle 182, rod 181, actuator142, and spring 150 are of a biocompatible metal material, such asstainless steel, but may be made from a non-metal material. All of theother components are made from a non-metal material. The anchors190,1000 and suture 500 are of a polymer material, which may or may notbe an absorbable polymer material. The actuator 142 may be coupled tothe shaft 141 and the needle 182 may be coupled to the rod 181 viamechanical means, adhesive means, such as a non-toxic, biocompatible,adhesive glue, or other means known to one of skill in the art. Thedevice 100 and its components are all made via a method known to one ofskill in the art, including, but not limited to injection molding.

As various modifications could be made to the exemplary embodiments, asdescribed above with reference to the corresponding illustrations,without departing from the scope of the disclosure, it is intended thatall matter contained in the foregoing description and shown in theaccompanying drawings shall be interpreted as illustrative rather thanlimiting. Thus, the breadth and scope of the present disclosure shouldnot be limited by any of the above-described exemplary embodiments, butshould be declined only in accordance with the following claims appendedhereto and their equivalents.

The invention claimed is:
 1. A tissue repair device comprising: a handleincluding a proximal end, a distal end, and a longitudinal axisextending therebetween; a knob including a shaft and a head coupled tothe shaft, the shaft disposed within the handle and the head disposedoutside of the handle; a slotted member disposed within the handle, aside of the slotted member including rails and a plurality of slotslocated between the rails, the rails spaced apart along an axis that istransverse to the longitudinal axis of the handle; a pusher assembly atleast partially disposed within the handle, the pusher assemblyincluding an actuator coupled to a disk member, a portion of the diskmember located in at least one of the plurality of slots; a needlecoupled to the handle; first and second anchors disposed within theneedle, the first and second anchors coupled via a flexible member thatincludes a knot located between the anchors; wherein the actuator is atleast partially disposed within the needle such that an end portion ofthe actuator is located proximal to the first anchor; and wherein theknob is coupleable with the pusher assembly such that distal movement ofthe knob deploys the first anchor from the needle.
 2. The tissue repairdevice of claim 1, wherein the handle includes a closed-ended proximalportion and an open distal portion.
 3. The tissue repair device of claim1, further comprising a hub for retaining the actuator.
 4. The tissuerepair device of claim 1, wherein a distal tip of the needle isconfigured for insertion into tissue.
 5. The tissue repair device ofclaim 1, wherein the needle is configured for retaining at least one ofthe first anchor and the second anchor.
 6. The tissue repair device ofclaim 1, wherein the handle extends along a longitudinal axis of theneedle.
 7. The tissue repair device of claim 1, wherein at least onecomponent thereof comprises a metal material, a polymer material, abiocompatible material.
 8. The tissue repair device of claim 1, whereinat least one of the flexible member, the first anchor, and the secondanchor comprise absorbable material.
 9. The tissue repair device ofclaim 1, wherein the knot comprises a slip knot.
 10. The tissue repairdevice of claim 1, further comprising a depth indicator configured tolimit insertion depth of the needle into tissue.
 11. The tissue repairdevice of claim 1, wherein the needle further comprises laser marks forindicating insertion depth of the needle into tissue.
 12. The tissuerepair device of claim 1, wherein at least one of the first and secondanchors include two through holes extending through a width of theanchor for passage of the flexible member.